kasper update

KASPER Update - 2014

David R. HopkinsKASPER Program ManagerOffice of Inspector GeneralKentucky Cabinet for Health and Family Services

Kentucky Coalition of Nurse Practitioners/Nurse MidwivesApril 15, 2014

Cabinet for Health and Family Services

Disclosure

• David R. Hopkins–No relevant financial relationships.–No conflicts of interest.


Contents

• Controlled Substance Abuse and Pill Mills

• KASPER Program Update• Legislative Changes Affecting APRN

Use of KASPER• HB1 Preliminary Results and

Evaluation

Controlled Substance Abuseand Pill Mills


Misuse, Abuse, Diversion

• Misuse:– When a schedule II – V substance is taken by an

individual for a non-medical reason.• Abuse:

– When an individual repeatedly takes a schedule II – V substance for a non-medical reason.

• Diversion:– When a schedule II – V substance is acquired

and/or taken by an individual for whom the medication was not prescribed.


Most Common Drug Treatment Admissions by State

Laura Dimon, MIC Network, Inc., February 10, 2014. Image credit: Fiona Breslin.


Prescription Drug Abuse in Kentucky

• 4.5% of Kentuckians (ages 12+) used prescription pain relievers for nonmedical reasons in past year. (KY ranks 31st in the nation) –National average = 4.6%–Kentucky down from 6.6% (tied for 2nd) in

2009

Source: Data from the 2007 through 2011 National Surveys on Drug Use and Health, published by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Statistics and Quality.


Drug Overdose Deaths in Kentucky

246339

435

551 525

621

711673

747 746

996 1,022 1,031

0

200

400

600

800

1000

1200

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Tota

l Num

ber

Kentucky Resident Drug Overdose Deaths, 2000-2012

Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009-2012 are provisional and subject to change.


Drug Overdose Death Rates in Kentucky


Kitson Clothing Collection

Story: WXIX Fox 19 Digital Media Staff, June 21, 2013


Philip Seymour Hoffman

US Weekly Celebrity News, February 3, 2014


Jeff and Chris George

Photos from Palm Beach Post


Dr. Paul H. Volkman

Story: Bill Estep, Lexington Herald-Leader, February 14, 2012. AP Photo released by U.S. Marshals Service (undated)


Care More Pain Management Clinic

Photo: Scott Utterback, Louisville Courier-Journal, January 25, 2012


Ernest William Singleton

Photo: Lexington Community Corrections, January 2013

KASPER Program Update


KASPER

KASPER is Kentucky’s Prescription Monitoring Program (PMP). KASPER tracks Schedule II – V controlled substance prescriptions dispensed within the state as reported by pharmacies and other dispensers.

Enhanced KASPER (eKASPER) is the real-time web accessed database that provides a tool to help address the misuse, abuse and diversion of controlled pharmaceutical substances.

Status of Prescription Drug Monitoring Programs (PDMPs)

Research is current as of February 1, 2012

AK

AL

AR

CACO

ID

IL INIA

MN

MO

MT

NENV

ND

OH

OK

OR

TN

UT

WA

AZ

SD

NM

VA

WYMI

GA

KS

HI

TX

ME

MS

WINY

PA

LA

KYNC

SC

FL

NHMARICTNJDEMD

DC

VT

WV

Operational PDMPs

Enacted PDMP legislation, but program not yet operational

Legislation pending

GU

2011 KASPER Reports Requested


Annual KASPER Records Total / Per Person


2.39 2.43 2.65 2.65 2.72 2.72 2.47Number of Controlled Substance Prescriptions per Person

KASPER Reports Requested



Top Prescribed Controlled Substances byTherapeutic Category by Doses - 2013

Hydrocodone 41.8% LortabLorcetVicodin

Alprazolam 11.3%Xanax

Tramadol 6.8%Ultram

Oxycodone 15.5% OxyContinPercodanPercocet

Clonazepam 6.8%Klonopin

Diazepam 4.3%Valium

Phentermine 2.9%

Adipex-P

Amphetamine 3.2%

Adderall

Zolpidem 3.4%Ambien

Lorazepam 4.0%Ativan

KASPER Stakeholders• Licensing Boards – to investigate potential inappropriate

prescribing by a licensee. • Practitioners and Pharmacists – to review a current

patient’s controlled substance prescription history for medical or pharmaceutical treatment.

• Law Enforcement Officers, OIG employees, Commonwealth’s attorneys, county attorneys - to review an individual’s controlled substance prescription history as part of a bona fide drug investigation or drug prosecution.

• Medicaid – to screen members for potential abuse of pharmacy benefits and to determine “lock-in”; to screen providers for adherence to prescribing guidelines for Medicaid patients.

• A judge or probation or parole officer – to help ensure adherence to drug diversion or probation program guidelines.

• Medical Examiners engaged in a death investigation



Goals of KASPER

• KASPER was designed as a tool to help address prescription drug abuse and diversion by providing:– A source of information for health care

professionals– An investigative tool for law enforcement and

regulatory agencies• KASPER was not designed to:

– Prevent people from obtaining prescription drugs

Legislative Changes AffectingAPRN Use of eKASPER


eKASPER Reporting KRS 218A.202

• Controlled substance administration or dispensing must be reported within one day effective July 1, 2013


eKASPER Accounts – KRS 218A.202

• eKASPER registration is mandatory for Kentucky practitioners or pharmacists authorized to prescribe or dispense controlled substances to humans.


KASPER Master Accounts

12/31/2011 04/24/2012 07/20/2012 02/24/2014

Doctor* 5,470 5,680 11,923 17,807

APRN 690 781 1,523 2,150

Pharmacist 1,385 1,450 3,602 5,363

Total 7,545 7,911 17,048 25,320

*Includes physicians, dentists, optometrists and podiatrists


eKASPER Prescriber Usage - KRS 218A.172

• eKASPER must be queried:– Prior to initial prescribing or dispensing of a

Schedule II controlled substance, or a Schedule III controlled substance containing hydrocodone

– No less than every three months– Before issuing a new prescription or refills

for a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone


Kentucky Board of Nursing Regulations

The Kentucky Board of Nursing has established additional KASPER query and prescribing standards that apply to an APRN with a CAPA-CS when prescribing a controlled substance

• Please review: 201 KAR 20:057

eKASPER Report Request



What if I cannot “Query” KASPER?

• If eKASPER indicates “manual process”– Record the eKASPER report request

number in the patient’s chart• If the eKASPER system is unavailable

or Internet access unavailable– Document circumstances why eKASPER

could not be queried– If eKASPER outage, record the date and

time, and eKASPER system outage logs will confirm lack of system availability


eKASPER Delegate Accounts

• eKASPER delegate accounts allowed for:

– An employee of the practitioner’s or pharmacist’s practice acting under the specific direction of the practitioner or pharmacist

eKASPER Delegate Account Request



eKASPER Prescriber Reports

• CS prescribers can obtain an eKASPER report on themselves:

– To review and assess the individual prescribing patterns

– To determine the accuracy and completeness of information contained in eKASPER

– To identify fraudulent prescriptions

eKASPER Prescriber Report



eKASPER Patient Reports

• eKASPER reports can be shared with the patient or person authorized to act on the patient’s behalf

• eKASPER reports can be placed in the patient’s medical record, with the report then being deemed a medical record subject to disclosure on the same terms and conditions as an ordinary medical record


eKASPER Error Correction

• Patient or provider should contact the dispenser to correct records in error

• Inaccurate KASPER reports due to system errors should be reported to the Drug Enforcement and Professional Practices Branch–502-564-7985

House Bill 1 Preliminary Resultsand Evaluation


Controlled Substance Dispensing – One Year Comparison

Drug August 2011 through

July 2012

August 2012through

July 2013

Change

Hydrocodone 239,037,354 214,349,392 -10.3%

Oxycodone 87,090,503 77,022,586 -11.6%

Oxymorphone 1,753,231 1,138,817 - 35.0%

Alprazolam 71,669,411 62,088,568 -13.4%

Methylphenidate 10,659,840 11,454,025 + 7.5%

Amphetamine 13,795,147 15,065,833 + 9.2%

All Controlled Substances 739,263,679 676,303,581 -8.5%

Figures shown in doses dispensed


HydrocodoneHydrocodone


OxycodoneOxycodone


AlprazolamAlprazolam


MethadoneMethadone


OxymorphoneOxymorphone


TramadolTramadol


BuprenorphineBuprenorphine


Controlled Substance Prescribing 2013


Controlled Substance Usage 2013


House Bill 1 Impact Study

• Comprehensive assessment of HB1’s impact on patients, prescribers, and other stakeholders

• Overall goals:– Evaluate the impact of HB1 on reducing prescription

drug abuse and diversion in Kentucky– Identify unintended consequences associated with

implementation of HB1 that impact patients, providers and citizens of the Commonwealth

– Develop recommendations to improve effectiveness of HB1 and mitigate identified unintended consequences

• Final study report planned for July 2014


Additional KASPER Projects • Improve KASPER data quality and patient identifiers

(ongoing)– Reduce manual reports– Reduce “blended” reports

• Technology platform upgrade (April 2014)– Improve system availability and response time

• Prescriber compliance reporting (June 2014)• Expand interstate data sharing to all border states

(except MO) (December 2014)• Integrate KASPER with the Kentucky Health

Information Exchange and EHR systems 2014-2015

David Hopkins502-564-2815 ext. [email protected]

kasper update - 2014 david r. hopkins kasper program manager office of inspector general kentucky...

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